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APPLICATION FOR ENCROACHMENT PERMIT <br /> PLEASE PRINT: <br /> P5- 13 a 3'�?_6 <br /> Date Z��5l OFFICE USE ONLY <br /> To: San Joaquin County JOB# REF# <br /> Department of Public Works APN CR# <br /> EXP. DATE <br /> VALIDs1z,013 DRIVEWAYS: <br /> Pacific Gas & Electric STREET C ( eMeA+ A►rc <br /> P.O. BOX 930 AREA 5 oe_IcInh QUAD c <br /> TYPE -PIP It 4-10 <br /> STOCKTON, CA 95201 FORMS 551 W,-9-2-go; noa <br /> 209-942-1627 NOTES <br /> Sketch(Detailed plans may be submitted) <br /> Traffic Control Plan <br /> shall be as per <br /> See attached sketch. current M.U.T.C.D. <br /> �I flCalifornia supplement <br /> PM �5�7� <br /> Notif. <br /> The undersigned hereby applies for permission to excavate,construct and/or otherwise encroach on County Highway Right-of-Way on <br /> the U side of OA-ew- approximately feet( <br /> of 5 GV-4on , by performing the f Ilowin work(description of work): <br /> ICcGG rY,! elf�� . 4fo fyw r Ila"C1G� ±2 <br /> " s tft ef . <br /> Work will commence on or about 2 for approximately days. <br /> I,the undersigned,certify that I am the owner of the respective property,or am qualified to represent the owner and agree to do the <br /> work described above in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br /> j <br /> un, <br /> � r I��1►� <br /> Signature of Applicant-Title Date <br /> E7Pu . KIMASTER.PSIENCROACHMENTPERMITAPPLICATION.DOC (01108) <br /> Return Permits to: <br /> CCD <br /> P.O. Box 930 <br /> Stockton, CA 95201-0930 <br />